Clinician Performance Information on Medicare Care Compare

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Clinician Performance Information on Medicare Care Compare 2020 Doctors and Clinicians Public Reporting

Overview

This document summarizes the clinician performance information, plain language measure and activity titles1, and utilization data that are available for preview and will be publicly reported on Medicare Care Compare and in the Provider Data Catalog (PDC) in 2022. The Centers for Medicare & Medicaid Services (CMS) will publicly report 2020 Quality Payment Program (QPP) clinician performance information. Performance information that meets statistical public reporting standards (valid, reliable, comparable, and meets the minimum reliability threshold) will be included in the PDC.2,3 A subset of this information will be added to Care Compare profile pages. Any information publicly reported on profile pages must also resonate with patients and caregivers, as shown through user testing. Per the Medicare and CHIP Reauthorization Act (MACRA), eligible clinicians’ final and performance category scores must be publicly reported.

1 Plain language measure and activity titles are used on Care Compare profile pages to allow patients and caregivers to more easily understand the information. See the 2020 Measures and Activities Plain Language Crosswalk posted on the Care Compare: Doctors and Clinicians Initiative page for more information. 2 MIPS quality and MIPS cost measures in their first 2 years of use won’t be publicly reported (§414.1395(c)). 3 Clinicians and groups who received an Extreme and Uncontrollable Circumstances (EUC) exception won’t have performance information to preview or available for public reporting.

The 2020 QPP clinician performance information that will be publicly reported on Care Compare and in the PDC includes Merit-based Incentive Payment System (MIPS) and Qualified Clinical Data Registry (QCDR) quality measures, MIPS Promoting Interoperability measures and attestations, MIPS improvement activities attestations, and final scores and performance category scores. The 2020 final scores and performance category scores (quality, Promoting Interoperability, improvement activities, and cost), as well as a subset of 2019 utilization data, will be publicly reported in the PDC. This performance information will be available for preview.

Under §414.1395(d), CMS provides a Preview Period for clinicians and groups to preview their 2020 QPP performance information before the data are publicly reported on Care Compare and in the PDC. For more information on previewing your performance information, visit the Care Compare: Doctors and Clinicians Initiative page and download the 2020 Doctors and Clinicians Preview Period User Guide.

For questions about public reporting for doctors and clinicians, contact the QPP Service Center at [email protected].

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Compare-DAC


mailto:[email protected]


2020 QPP Clinician Performance Information

Questions or feedback? Contact the QPP Service Center at [email protected]. of 25

Publicly Reported Performance Information

MIPS Quality Measures CMS will publicly report 65 clinician MIPS quality measures as star ratings on Care Compare profile pages and 133 clinician MIPS quality measures in the PDC.

Measure #A Technical Measure Title Meaningful Measure Area

Collection Type(s)

Profile Page PDC

1 Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

Management of Chronic Conditions

eCQM No Yes

5 Heart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) or Angiotensin Receptor-Neprilysin Inhibitor (ARNI) Therapy for Left Ventricular Systolic Dysfunction (LVSD)


eCQM No Yes

6 Coronary Artery Disease (CAD): Antiplatelet Therapy


MIPS CQM Yes Yes

7 Coronary Artery Disease (CAD): Beta-Blocker Therapy - Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF < 40%)


eCQM No Yes

8 Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)


eCQM No Yes

9.1A Anti-Depressant Medication Management

Prevention, Treatment, and Management of Mental Health

eCQM No Yes

9.2 A Anti-Depressant Medication Management


eCQM No Yes

12 Primary Open-Angle Glaucoma (POAG): Optic Nerve Evaluation


eCQM Yes Yes

14 Age-Related Macular Degeneration (AMD): Dilated Macular Examination


MIPS CQM Yes Yes

19 Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

Transfer of Health Information and Interoperability

MIPS CQM, eCQM

Yes Yes

21 Perioperative Care: Selection of Prophylactic Antibiotic - First OR Second-Generation Cephalosporin

Healthcare-Associated Infections

MIPS CQM No Yes




Collection Type(s)

Profile Page PDC

23 Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)

Preventive Care Medicare Part B Claims

No Yes

24 Communication with the Physician or Other Clinician Managing On-Going Care Post-Fracture for Men and Women Aged 50 Years and Older


MIPS CQM Yes Yes

39 Screening for Osteoporosis for Women Aged 65-85 Years of Age

Preventive Care Medicare Part B Claims, MIPS CQM

Yes Yes

44 Coronary Artery Bypass Graft (CABG): Preoperative Beta-Blocker in Patients with Isolated CABG Surgery

Medication Management

MIPS CQM No Yes

Yes 47 Advance Care Plan Care is Personalized and Aligned with Patient's Goals

Medicare Part B Claims, MIPS CQM

Yes

Yes 48 Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence in Women Aged 65 Years and Older


Yes

50 Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65 Years and Older


MIPS CQM Yes Yes

52 Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy


MIPS CQM Yes Yes

65 Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Appropriate Use of Healthcare

eCQM No Yes

66 Appropriate Testing for Children with Pharyngitis


eCQM No Yes

76 Prevention of Central Venous Catheter (CVC) - Related Bloodstream Infections

Healthcare-Associated Infections

MIPS CQM No Yes

93 Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy - Avoidance of Inappropriate Use


MIPS CQM No Yes

107 Adult Major Depressive Disorder (MDD): Suicide Risk Assessment


eCQM Yes Yes




Collection Type(s)

Profile Page PDC

110 Preventive Care and Screening: Influenza Immunization

Preventive Care Medicare Part B Claims, MIPS CQM, eCQM

Yes Yes

111 Pneumococcal Vaccination Status for Older Adults


Yes Yes

112 Breast Cancer Screening Preventive Care Medicare Part B Claims, MIPS CQM, eCQM

Yes Yes

113 Colorectal Cancer Screening Preventive Care Medicare Part B Claims, MIPS CQM, eCQM

Yes Yes

116 Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis


MIPS CQM No Yes

117 Diabetes: Eye Exam Management of Chronic Conditions

MIPS CQM, eCQM

Yes Yes

118 Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)


MIPS CQM No Yes

119 Diabetes: Medical Attention for Nephropathy


MIPS CQM, eCQM

Yes Yes

126 Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation

Preventive Care MIPS CQM Yes Yes

127 Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear


128 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan


Yes Yes

130 Documentation of Current Medications in the Medical Record


MIPS CQM, eCQM

Yes Yes

134 Preventive Care and Screening: Screening for Depression and Follow-Up Plan


Medicare Part B Claims, MIPS CQM, eCQM

Yes Yes

137 Melanoma: Continuity of Care - Recall System

Preventive Care MIPS CQM No Yes




Collection Type(s)

Profile Page PDC

138 Melanoma: Coordination of Care


MIPS CQM Yes Yes

143 Oncology: Medical and Radiation - Pain Intensity Quantified


MIPS CQM, eCQM

Yes Yes

144 Oncology: Medical and Radiation - Plan of Care for Moderate to Severe Pain


MIPS CQM Yes Yes

145 Radiology: Exposure Dose Indices or Exposure Time and Number of Images Reported for Procedures Using Fluoroscopy


Medicare Part B Claims

Yes Yes

146 Radiology: Inappropriate Use of "Probably Benign" Assessment Category in Screening Mammograms



No Yes

147 Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy



No Yes

154 Falls: Risk Assessment Preventable Healthcare Harm

MIPS CQM No Yes

155 Falls: Plan of Care Preventable Healthcare Harm


Yes Yes

176 Rheumatoid Arthritis (RA): Tuberculosis Screening


MIPS CQM Yes Yes

177 Rheumatoid Arthritis (RA): Periodic Assessment of Disease Activity


MIPS CQM Yes Yes

178 Rheumatoid Arthritis (RA): Functional Status Assessment

Patient's Experience of Care

MIPS CQM Yes Yes

180 Rheumatoid Arthritis (RA): Glucocorticoid Management


MIPS CQM No Yes

181 Elder Maltreatment Screen and Follow-Up Plan


Yes Yes

182 Functional Outcome Assessment

Patient Reported Functional Outcomes

MIPS CQM No Yes

185 Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use


MIPS CQM Yes Yes

191 Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery


eCQM No Yes




Collection Type(s)

Profile Page PDC

195 Radiology: Stenosis Measurement in Carotid Imaging Reports

Preventable Healthcare Harm


No Yes

225 Radiology: Reminder System for Screening Mammograms

Preventive Care Medicare Part B Claims

No Yes

226.1 A Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Prevention and Treatment of Opioid and Substance Use Disorders

eCQM No Yes



eCQM No Yes



Medicare Part B Claims, MIPS CQM, eCQM

Yes Yes

236 Controlling High Blood Pressure


eCQM No Yes

238.1 A Use of High-Risk Medications in the Elderly


eCQM Yes Yes

238.2 A Use of High-Risk Medications in the Elderly


eCQM No Yes

239.1 A Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

Preventive Care eCQM No Yes





240 Childhood Immunization Status


243 Cardiac Rehabilitation Patient Referral from an Outpatient Setting


265 Biopsy Follow-Up Transfer of Health Information and Interoperability

MIPS CQM Yes Yes

268 Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy


MIPS CQM No Yes

277 Sleep Apnea: Severity Assessment at Initial Diagnosis


MIPS CQM Yes Yes




Collection Type(s)

Profile Page PDC

279 Sleep Apnea: Assessment of Adherence to Positive Airway Pressure Therapy


MIPS CQM Yes Yes

281 Dementia: Cognitive Assessment


eCQM Yes Yes

282 Dementia: Functional Status Assessment


MIPS CQM Yes Yes

283 Dementia Associated Behavioral and Psychiatric Symptoms Screening and Management


MIPS CQM Yes Yes

286 Dementia: Safety Concern Screening and Follow-Up for Patients with Dementia


MIPS CQM No Yes

288 Dementia: Education and Support of Caregivers for Patients with Dementia


MIPS CQM Yes Yes

290 Parkinson's Disease: Psychiatric Symptoms Assessment for Patients with Parkinson's Disease


MIPS CQM Yes Yes

291 Parkinson's Disease: Cognitive Impairment or Dysfunction Assessment for Patients with Parkinson's Disease


MIPS CQM Yes Yes

293 Parkinson's Disease: Rehabilitative Therapy Options


MIPS CQM Yes Yes

305.1 A Initiation and Engagement of Alcohol and Other Drug Dependence Treatment


eCQM No Yes

305.2 A Initiation and Engagement of Alcohol and Other Drug Dependence Treatment


eCQM No Yes

309 Cervical Cancer Screening Preventive Care eCQM No Yes 310 Chlamydia Screening for

Women Preventive Care eCQM No Yes

318 Falls: Screening for Future Fall Risk


eCQM Yes Yes

320 Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients



Yes Yes




Collection Type(s)

Profile Page PDC

322 Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Preoperative Evaluation in Low-Risk Surgery Patients


MIPS CQM Yes Yes

324 Cardiac Stress Imaging Not Meeting Appropriate Use Criteria: Testing in Asymptomatic, Low-Risk Patients


MIPS CQM No Yes

326 Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy


MIPS CQM Yes Yes

331 Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)


MIPS CQM Yes Yes

332 Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)


MIPS CQM No Yes

333 Adult Sinusitis: Computerized Tomography (CT) for Acute Sinusitis (Overuse)


MIPS CQM No Yes

337 Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis on a Biological Immune Response Modifier


350 Total Knee Replacement: Shared Decision-Making: Trial of Conservative (Non-surgical) Therapy

Care is Personalized and Aligned with Patient's Goals

MIPS CQM No Yes

351 Total Knee Replacement: Venous Thromboembolic and Cardiovascular Risk Evaluation


358 Patient-Centered Surgical Risk Assessment and Communication

Care is Personalized and Aligned with Patient's Goals

MIPS CQM Yes Yes

360 Optimizing Patient Exposure to Ionizing Radiation: Count of Potential High Dose Radiation Imaging Studies: Computed Tomography (CT) and Cardiac Nuclear Medicine Studies


MIPS CQM Yes Yes




Collection Type(s)

Profile Page PDC

364 Optimizing Patient Exposure to Ionizing Radiation: Appropriateness: Follow-up CT Imaging for Incidentally Detected Pulmonary Nodules According to Recommended Guidelines


MIPS CQM No Yes

370.1 A Depression Remission at Twelve Months


eCQM No Yes

370.2 A Depression Remission at Twelve Months


eCQM No Yes

374 Closing the Referral Loop: Receipt of Specialist Report


MIPS CQM, eCQM

Yes Yes

375 Functional Status Assessment for Total Knee Replacement


eCQM No Yes

376 Functional Status Assessment for Total Hip Replacement


eCQM No Yes

377 Functional Status Assessments for Congestive Heart Failure


eCQM No Yes

379 Primary Caries Prevention Intervention as Offered by Primary Care Providers, including Dentists


394.1 A Immunizations for Adolescents








398.1 A Optimal Asthma Control Management of Chronic Conditions

MIPS CQM No Yes


MIPS CQM No Yes


MIPS CQM No Yes


MIPS CQM No Yes

400 One-Time Screening for Hepatitis C Virus (HCV) for Patients at Risk


402 Tobacco Use and Help with Quitting Among Adolescents


MIPS CQM No Yes




Collection Type(s)

Profile Page PDC

405 Appropriate Follow-up Imaging for Incidental Abdominal Lesions


MIPS CQM Yes Yes

406 Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients


MIPS CQM Yes Yes

408 Opioid Therapy Follow-up Evaluation


MIPS CQM Yes Yes

410 Psoriasis: Clinical Response to Systemic Medications


MIPS CQM Yes Yes

412 Documentation of Signed Opioid Treatment Agreement


MIPS CQM Yes Yes

414 Evaluation or Interview for Risk of Opioid Misuse


MIPS CQM Yes Yes

419 Overuse of Imaging for the Evaluation of Primary Headache


MIPS CQM Yes Yes

424 Perioperative Temperature Management


MIPS CQM No Yes

425 Photodocumentation of Cecal Intubation


MIPS CQM No Yes

430 Prevention of Post-Operative Nausea and Vomiting (PONV) - Combination Therapy


431 Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling


MIPS CQM Yes Yes

435 Quality of Life Assessment For Patients With Primary Headache Disorders


MIPS CQM Yes Yes

436 Radiation Consideration for Adult CT: Utilization of Dose Lowering Techniques



No Yes

438 Statin Therapy for the Prevention and Treatment of Cardiovascular Disease


MIPS CQM Yes Yes

439 Age Appropriate Screening Colonoscopy


MIPS CQM No Yes

440 Skin Cancer: Biopsy Reporting Time - Pathologist to Clinician


MIPS CQM No Yes




Collection Type(s)

Profile Page PDC

441 Ischemic Vascular Disease (IVD) All or None Outcome Measure (Optimal Control)


MIPS CQM No Yes

463 Prevention of Post-Operative Vomiting (POV) - Combination Therapy (Pediatrics)


464 Otitis Media with Effusion: Systemic Antimicrobials - Avoidance of Inappropriate Use


MIPS CQM No Yes

A Measure and performance rate details are available on the QPP website. For measures with more than one performance rate, the rate is indicated using a decimal number.

QCDR Quality Measures CMS will publicly report 11 clinician QCDR measures as star ratings on Care Compare profile pages and 20 QCDR measures in the PDC.

Measure #B Technical Measure Title Collection Type

Profile Page PDC

AAN5 Medication Prescribed For Acute Migraine Attack MIPS CQM No Yes AAN8 Exercise and Appropriate Physical Activity Counseling for

Patients with MS MIPS CQM Yes Yes

AAN9 Querying About Symptoms of Autonomic Dysfunction for Patients with Parkinson's Disease

MIPS CQM Yes Yes

AAN10 Falls screening (aggregation of AAN disease specific falls measures)

MIPS CQM Yes Yes

AAO17 Age-related Hearing Loss: Advanced Diagnostic Imaging of Bilateral Presbycusis or Symmetric SNHL

MIPS CQM No Yes

AAO23 Allergic Rhinitis: Intranasal Corticosteroids or Oral Antihistamines

MIPS CQM Yes Yes

AAO24 Allergic Rhinitis: Avoidance of Leukotriene Inhibitors MIPS CQM No Yes AQI48.1 B Patient-Reported Experience with Anesthesia MIPS CQM No Yes CDR1.1 B Adequate Off-loading of Diabetic Foot Ulcer at each visit MIPS CQM No Yes CDR1.2 B Adequate Off-loading of Diabetic Foot Ulcer at each visit MIPS CQM No Yes CDR1.3 B Adequate Off-loading of Diabetic Foot Ulcer at each visit MIPS CQM Yes Yes GIQIC12 Appropriate indication for colonoscopy MIPS CQM Yes Yes GIQIC15 Appropriate follow-up interval of 3 years recommended

based on pathology findings from screening colonoscopy in average-risk patients

MIPS CQM No Yes

GIQIC19 Appropriate indication for esophagogastroduodenoscopy (EGD)

MIPS CQM Yes Yes

IRIS2 Glaucoma-Intraocular Pressure Reduction MIPS CQM Yes Yes NHCR4 Repeat screening or surveillance colonoscopy

recommended within one year due to inadequate/poor bowel preparation

MIPS CQM Yes Yes

PIMSH1 Oncology: Advance Care Planning in Metastatic Cancer Patients

MIPS CQM Yes Yes

https://qpp.cms.gov/mips/explore-measures/quality-measures?tab=qualityMeasures&py=2019



Measure #B Technical Measure Title Collection Type

Profile Page PDC

STS7 Patient Centered Surgical Risk Assessment and Communication for Cardiac Surgery

MIPS CQM Yes Yes

USWR23.1 B Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential

MIPS CQM No Yes

USWR23.4 Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential

MIPS CQM No Yes

B Measure and performance rate details are available on the QPP website. For measures with more than one performance rate, the rate is indicated using a decimal number.

MIPS Promoting Interoperability Measures CMS will publicly report 4 clinician MIPS Promoting Interoperability measures as star ratings on Care Compare profile pages and 4 clinician MIPS Promoting Interoperability measures in the PDC.

Measure # Technical Measure Title Collection type(s) Profile Page PDC

PI_EP_1 e-Prescribing Web attestation, MIPS CQM, eCQM

Yes Yes

PI_HIE_1 Support Electronic Referral Loops By Sending Health Information

Web attestation, MIPS CQM, eCQM

Yes Yes

PI_HIE_4 Support Electronic Referral Loops By Receiving and Incorporating Health Information


Yes Yes

PI_PEA_1 Provide Patients Electronic Access to Their Health Information


Yes Yes

MIPS Promoting Interoperability Indicators and Attestations CMS will publicly report the following indicators on clinician profile pages:

• A yellow caution symbol and plain language description if a clinician attested negatively to one or more of the 2020 prevention of information blocking attestations, and

• A green checkmark and plain language description if a clinician successfully reported the Promoting Interoperability performance category by achieving a Promoting Interoperability performance category score above zero.

CMS will publicly report 8 clinician MIPS Promoting Interoperability attestations as checkmarks on profile pages, and 33 clinician MIPS Promoting Interoperability attestations in the PDC.


PI_EP_2 Query of the Prescription Drug Monitoring Program (PDMP)


Yes Yes

PI_INFBLO_1 Prevention of Information Blocking Attestation


Yes Yes

https://qpp.cms.gov/mips/explore-measures/quality-measures?py=2018#measures




PI_LVITC_2 Support Electronic Referral Loops By Receiving and Incorporating Health Information Exclusion


No Yes

PI_LVOTC_1 Support Electronic Referral Loops By Sending Health Information Exclusion


No Yes

PI_LVPP_1 e-Prescribing Exclusion Web attestation, MIPS CQM, eCQM

No Yes

PI_ONCACB_1 ONC-ACB Surveillance Attestation


No Yes

PI_ONCDIR_1 ONC Direct Review Attestation


No Yes

PI_PHCDRR_1 Immunization Registry Reporting


Yes Yes

PI_PHCDRR_1_EX_1 Immunization Registry Reporting Exclusion


No Yes



No Yes



No Yes

PI_PHCDRR_1_MULTI Immunization Registry Reporting for Multiple Registry Engagement


No Yes

PI_PHCDRR_2 Syndromic Surveillance Reporting


Yes Yes

PI_PHCDRR_2_EX_1 Syndromic Surveillance Reporting Exclusion


No Yes



No Yes



No Yes

PI_PHCDRR_2_MULTI Syndromic Surveillance Reporting for Multiple Registry Engagement


No Yes

PI_PHCDRR_3 Electronic Case Reporting Web attestation, MIPS CQM, eCQM

Yes Yes

PI_PHCDRR_3_EX_1 Electronic Case Reporting Exclusion


No Yes



No Yes



No Yes

PI_PHCDRR_3_MULTI Electronic Case Reporting for Multiple Registry Engagement


No Yes

PI_PHCDRR_4 Public Health Registry Reporting


Yes Yes

PI_PHCDRR_4_EX_1 Public Health Registry Reporting Exclusion


No Yes






No Yes



No Yes

PI_PHCDRR_4_MULTI Public Health Registry Reporting for Multiple Registry Engagement


No Yes

PI_PHCDRR_5 Clinical Data Registry Reporting


Yes Yes

PI_PHCDRR_5_EX_1 Clinical Data Registry Reporting Exclusion


No Yes



No Yes



No Yes

PI_PHCDRR_5_MULTI Clinical Data Registry Reporting for Multiple Registry Engagement


No Yes

PI_PPHI_1 Security Risk Analysis Web attestation, MIPS CQM, eCQM

Yes Yes

MIPS Improvement Activities Attestations CMS will publicly report 106 clinician MIPS improvement activities attestations as checkmarks on Care Compare profile pages and 106 clinician MIPS improvement activities attestations in the PDC.4

4 A maximum of 10 attestations per profile page will be reported according to user preference. For reporters with more than 10 attestations, the 10 most highly reported attestations by entity will be selected for public reporting on Care Compare profile pages. All MIPS improvement activities that meet the public reporting standards will be made publicly available in the PDC.

Activity # Technical Activity Title Collection type(s) Profile Page PDC

IA_AHE_1 Engagement of New Medicaid Patients and Follow-up


Yes Yes

IA_AHE_3 Promote Use of Patient-Reported Outcome Tools


Yes Yes

IA_AHE_5 MIPS Eligible Clinician Leadership in Clinical Trials or CBPR


Yes Yes

IA_AHE_6 Provide Education Opportunities for New Clinicians


Yes Yes

IA_AHE_7 Comprehensive Eye Exams Web attestation, MIPS CQM, eCQM

Yes Yes

IA_BE_1 Use of certified EHR to capture patient reported outcomes


Yes Yes

IA_BE_3 Engagement with QIN-QIO to implement self-management training programs


Yes Yes




IA_BE_4 Engagement of patients through implementation of improvements in patient portal


Yes Yes

IA_BE_5 Enhancements/regular updates to practice websites/tools that also include considerations for patients with cognitive disabilities


Yes Yes

IA_BE_6 Collection and follow-up on patient experience and satisfaction data on beneficiary engagement


Yes Yes

IA_BE_7 Participation in a QCDR, that promotes use of patient engagement tools.


Yes Yes

IA_BE_8 Participation in a QCDR, that promotes collaborative learning network opportunities that are interactive.


Yes Yes

IA_BE_12 Use evidence-based decision aids to support shared decision-making.


Yes Yes

IA_BE_13 Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.


Yes Yes

IA_BE_14 Engage Patients and Families to Guide Improvement in the System of Care


Yes Yes

IA_BE_15 Engagement of Patients, Family, and Caregivers in Developing a Plan of Care


Yes Yes

IA_BE_16 Evidenced-based techniques to promote self-management into usual care


Yes Yes

IA_BE_17 Use of tools to assist patient self-management


Yes Yes

IA_BE_18 Provide peer-led support for self-management.


Yes Yes

IA_BE_19 Use group visits for common chronic conditions (e.g., diabetes).


Yes Yes

IA_BE_20 Implementation of condition-specific chronic disease self-management support programs


Yes Yes

IA_BE_21 Improved Practices that Disseminate Appropriate Self-Management Materials


Yes Yes

IA_BE_22 Improved Practices that Engage Patients Pre-Visit


Yes Yes

IA_BE_23 Integration of patient coaching practices between visits


Yes Yes

IA_BE_24 Financial Navigation Program Web attestation, MIPS CQM, eCQM

Yes Yes

IA_BE_25 Drug Cost Transparency Web attestation, MIPS CQM, eCQM

Yes Yes

IA_BMH_1 Diabetes screening Web attestation, MIPS CQM, eCQM

Yes Yes




IA_BMH_2 Tobacco use Web attestation, MIPS CQM, eCQM

Yes Yes

IA_BMH_4 Depression screening Web attestation, MIPS CQM, eCQM

Yes Yes

IA_BMH_5 MDD prevention and treatment interventions


Yes Yes

IA_BMH_6 Implementation of co-location PCP and MH services


Yes Yes

IA_BMH_7 Implementation of Integrated Patient Centered Behavioral Health Model


Yes Yes

IA_BMH_8 Electronic Health Record Enhancements for BH data capture


Yes Yes

IA_BMH_9 Unhealthy Alcohol Use for Patients with Co-occurring Conditions of Mental Health and Substance Abuse and Ambulatory Care Patients


Yes Yes

IA_BMH_10 Completion of Collaborative Care Management Training Program


Yes Yes

IA_CC_1 Implementation of Use of Specialist Reports Back to Referring Clinician or Group to Close Referral Loop


Yes Yes

IA_CC_2 Implementation of improvements that contribute to more timely communication of test results


Yes Yes

IA_CC_5 CMS partner in Patients Hospital Engagement Network


Yes Yes

IA_CC_7 Regular training in care coordination Web attestation, MIPS CQM, eCQM

Yes Yes

IA_CC_8 Implementation of documentation improvements for practice/process improvements


Yes Yes

IA_CC_9 Implementation of practices/processes for developing regular individual care plans


Yes Yes

IA_CC_10 Care transition documentation practice improvements


Yes Yes

IA_CC_11 Care transition standard operational improvements


Yes Yes

IA_CC_12 Care coordination agreements that promote improvements in patient tracking across settings


Yes Yes

IA_CC_13 Practice Improvements for Bilateral Exchange of Patient Information


Yes Yes

IA_CC_14 Practice Improvements that Engage Community Resources to Support Patient Health Goals


Yes Yes

IA_CC_15 PSH Care Coordination Web attestation, MIPS CQM, eCQM

Yes Yes




IA_CC_16 Primary Care Physician and Behavioral Health Bilateral Electronic Exchange of Information for Shared Patients


Yes Yes

IA_CC_17 Patient Navigator Program Web attestation, MIPS CQM, eCQM

Yes Yes

IA_CC_18 Relationship-Centered Communication Web attestation, MIPS CQM, eCQM

Yes Yes

IA_CC_19 Tracking of clinician's relationship to and responsibility for a patient by reporting MACRA patient relationship codes.


Yes Yes

IA_EPA_1 Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record


Yes Yes

IA_EPA_2 Use of telehealth services that expand practice access


Yes Yes

IA_EPA_3 Collection and use of patient experience and satisfaction data on access


Yes Yes

IA_EPA_4 Additional improvements in access as a result of QIN/QIO TA


Yes Yes

IA_EPA_5 Participation in User Testing of the Quality Payment Program Website (


Yes Yes

https://qpp.cms.gov/) IA_ERP_1 Participation on Disaster Medical

Assistance Team, registered for 6 months.


Yes Yes

IA_ERP_2 Participation in a 60-day or greater effort to support domestic or international humanitarian needs.


Yes Yes

IA_ERP_3 COVID-19 Clinical Trials Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PCMH Electronic submission of Patient Centered Medical Home accreditation


Yes Yes

IA_PM_2 Anticoagulant Management Improvements


Yes Yes

IA_PM_3 RHC, IHS or FQHC quality improvement activities


Yes Yes

IA_PM_4 Glycemic management services Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PM_5 Engagement of community for health status improvement


Yes Yes

IA_PM_6 Use of toolsets or other resources to close healthcare disparities across communities


Yes Yes

IA_PM_7 Use of QCDR for feedback reports that incorporate population health


Yes Yes

IA_PM_11 Regular Review Practices in Place on Targeted Patient Population Needs


Yes Yes

https://qpp.cms.gov/




IA_PM_12 Population empanelment Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PM_13 Chronic Care and Preventative Care Management for Empaneled Patients


Yes Yes

IA_PM_14 Implementation of methodologies for improvements in longitudinal care management for high risk patients


Yes Yes

IA_PM_15 Implementation of episodic care management practice improvements


Yes Yes

IA_PM_16 Implementation of medication management practice improvements


Yes Yes

IA_PM_17 Participation in Population Health Research


Yes Yes

IA_PM_18 Provide Clinical-Community Linkages Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PM_19 Glycemic Screening Services Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PM_20 Glycemic Referring Services Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PM_21 Advance Care Planning Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_1 Participation in an AHRQ-listed patient safety organization.


Yes Yes

IA_PSPA_2 Participation in MOC Part IV Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_3 Participate in IHI Training/Forum Event; National Academy of Medicine, AHRQ Team STEPPSÂ® or Other Similar Activity


Yes Yes

IA_PSPA_4 Administration of the AHRQ Survey of Patient Safety Culture


Yes Yes

IA_PSPA_6 Consultation of the Prescription Drug Monitoring Program


Yes Yes

IA_PSPA_7 Use of QCDR data for ongoing practice assessment and improvements


Yes Yes

IA_PSPA_8 Use of Patient Safety Tools Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_9 Completion of the AMA STEPS Forward program


Yes Yes

IA_PSPA_10 Completion of training and receipt of approved waiver for provision opioid medication-assisted treatments


Yes Yes

IA_PSPA_11 Participation in CAHPS or other supplemental questionnaire


Yes Yes

IA_PSPA_12 Participation in private payer CPIA Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_13 Participation in Joint Commission Evaluation Initiative


Yes Yes

IA_PSPA_15 Implementation of an ASP Web attestation, MIPS CQM, eCQM

Yes Yes




IA_PSPA_16 Use of decision support and standardized treatment protocols


Yes Yes

IA_PSPA_17 Implementation of analytic capabilities to manage total cost of care for practice population


Yes Yes

IA_PSPA_18 Measurement and Improvement at the Practice and Panel Level


Yes Yes

IA_PSPA_19 Implementation of formal quality improvement methods, practice changes, or other practice improvement processes


Yes Yes

IA_PSPA_20 Leadership engagement in regular guidance and demonstrated commitment for implementing practice improvement changes


Yes Yes

IA_PSPA_21 Implementation of fall screening and assessment programs


Yes Yes

IA_PSPA_22 CDC Training on CDC's Guideline for Prescribing Opioids for Chronic Pain


Yes Yes

IA_PSPA_23 Completion of CDC Training on Antibiotic Stewardship


Yes Yes

IA_PSPA_25 Cost Display for Laboratory and Radiographic Orders


Yes Yes

IA_PSPA_26 Communication of Unscheduled Visit for Adverse Drug Event and Nature of Event


Yes Yes

IA_PSPA_27 Invasive Procedure or Surgery Anticoagulation Medication Management


Yes Yes

IA_PSPA_28 Completion of an Accredited Safety or Quality Improvement Program


Yes Yes

IA_PSPA_29 Consulting AUC Using Clinical Decision Support when Ordering Advanced


Yes Yes

IA_PSPA_30 PCI Bleeding Campaign Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_31 Patient Medication Risk Education Web attestation, MIPS CQM, eCQM

Yes Yes

IA_PSPA_32 Use of CDC Guideline for Clinical Decision Support to Prescribe Opioids for Chronic Pain via Clinical Decision Support


Yes Yes

Overall MIPS Performance Per section 1848(q)(9)(A) of the Social Security Act, eligible clinicians’ overall MIPS performance information must be publicly reported. CMS will publicly report 2020 final scores and performance category scores for quality, Promoting Interoperability, improvement activities, and cost. Due to the ongoing Public Health Emergency (PHE), the cost performance category was re-weighted to zero.



Type of score Collection Type

Profile Page PDC

Final Score All - Quality performance category score All - Promoting Interoperability performance category score5 All - Improvement activities performance category score All - Cost performance category score All - NA

5 A score of 50 or above, which is included in the PDC, indicates that the clinician achieved the base score for the Promoting Interoperability performance category (83 FR 59913).

Utilization Data As required by Section 104(3) of MACRA, CMS will publicly report 2019 clinician utilization data for a subset of Healthcare Common Procedure Coding System (HCPCS) codes. The subset of publicly reported HCPCS codes are based on the top five codes reported by each available Medicare specialty, excluding evaluation and management (E&M) codes. A total of 245 HCPCS codes have been selected for public reporting in the PDC.

HCPCS Code Code Description 142 Anesthesia for lens surgery 731 Anesthesia for procedure on esophagus, stomach, and/or upper small bowel using an endoscope 790 Anesthesia for procedure in upper abdomen including use of an endoscope 811 Anesthesia for procedure on large bowel using an endoscope 812 Anesthesia for diagnostic examination of large bowel using an endoscope 813 Anesthesia for procedure on esophagus, stomach, small bowel, and/or large bowel using an endoscope 1402 Anesthesia for open or endoscopic total knee joint replacement 11042 Removal of skin and tissue first 20 sq cm or less 11045 Removal of skin and tissue 11055 Removal of single thickened skin growth 11056 Removal of 2 to 4 thickened skin growths 11102 Tangential biopsy of single skin lesion 11103 Tangential biopsy of additional skin lesion 11642 Removal of malignant growth (1.1 to 2.0 centimeters) of the face, ears, eyelids, nose, or lips 11720 Removal of tissue from 1 to 5 finger or toe nails 11721 Removal of tissue from 6 or more finger or toe nails 13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs 13132 Repair of wound (2.6 to 7.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands,

and/or feet 14060 Tissue transfer repair of wound (10 sq centimeters or less) of eyelids, nose, ears, and/or lips 17000 Destruction of skin growth 17003 Destruction of 2-14 skin growths 17110 Destruction of up to 14 skin growths 17250 Application of chemical agent to excessive wound tissue 19301 Partial removal of breast 20550 Injections of tendon sheath, ligament, or muscle membrane 20610 Aspiration and/or injection of large joint or joint capsule 20611 Aspiration and/or injection of major joint or joint capsule with recording and reporting using ultrasound

guidance



HCPCS Code Code Description 21025 Removal of lower jaw bone 21026 Removal of facial bones 21085 Impression and custom preparation of oral surgical splint 21208 Incision and repair of bony defect of cheek bone with repositioning of bony segment 21210 Repair of nasal or cheek bone with bone graft 21215 Repair of lower jaw bone with bone graft 22614 Fusion of spine bones, posterior or posterolateral approach 22842 Insertion of posterior spinal instrumentation for spinal stabilization, 3 to 6 vertebral segments 22853 Insertion of device into intervertebral disc space of spine and fusion of vertebrae 26055 Incision of tendon covering 27096 Injection procedure into sacroiliac joint for anesthetic or steroid 27447 Repair of knee joint 31231 Diagnostic examination of nasal passages using an endoscope 31500 Emergent insertion of breathing tube into windpipe cartilage using an endoscope 31575 Diagnostic examination of voice box using flexible endoscope 32674 Removal of lymph nodes of mid-chest cavity using an endoscope 33361 Replacement of aortic valve with prosthetic valve, accessed through the skin 33405 Replacement of aortic valve using artificial valve on heart-lung machine, open procedure 33508 Harvest of veins for coronary artery bypass procedure using an endoscope 33518 Combined multiple vein and artery heart artery bypasses 33533 Heart artery bypass to repair one artery 36415 Insertion of needle into vein for collection of blood sample 36556 Insertion of central venous catheter for infusion, patient 5 years or older 36561 Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or

older 36620 Insertion of arterial catheter for blood sampling or infusion, accessed through the skin 38525 Biopsy or removal of lymph nodes of under the arm, open procedure 38570 Removal of abdominal cavity lymph nodes using an endoscope 38900 Lymph node imaging during surgery 40808 Biopsy of mouth 40812 Removal of growth of mouth 43235 Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope 43239 Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope 45378 Diagnostic examination of large bowel using an endoscope 45380 Biopsy of large bowel using an endoscope 45385 Removal of polyps or growths of large bowel using an endoscope 46221 Removal of hemorrhoid by rubber banding 46600 Diagnostic examination of the anus using an endoscope 47562 Removal of gallbladder using an endoscope 51741 Electronic assessment of bladder emptying 51798 Ultrasound measurement of bladder capacity after voiding 52000 Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope 52332 Insertion of stent in urinary duct (ureter) using an endoscope 55700 Biopsy of prostate gland 58571 Abdominal removal of uterus (250 grams or less) with removal of tubes and/or ovaries using an endoscope 62323 Injection of substance into spinal canal of lower back or sacrum using imaging guidance 63047 Partial removal of middle spine bone with release of spinal cord and/or nerves 63048 Partial removal of spine bone with release of spinal cord and/or nerves 64483 Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance



HCPCS Code Code Description 64493 Injections of lower or sacral spine facet joint using imaging guidance 64494 Injections of lower or sacral spine facet joint using imaging guidance 64635 Destruction of lower or sacral spinal facet joint nerves using imaging guidance 69210 Removal of impact ear wax, one ear 70355 X-ray imaging of teeth 71046 X-ray of chest, 2 views 71250 CT scan chest 73030 X-ray of shoulder, minimum of 2 views 73110 X-ray of wrist, minimum of 3 views 73130 X-ray of hand, minimum of 3 views 73140 X-ray of fingers, minimum of 2 views 73502 X-ray of hip with pelvis, 2-3 views 73562 X-ray of knee, 3 views 73564 X-ray of knee, 4 or more views 73630 X-ray of foot, minimum of 3 views 74176 CT scan of abdomen and pelvis 74177 CT scan of abdomen and pelvis with contrast 76536 Ultrasound of head and neck 76830 Ultrasound pelvis through vagina 76872 Ultrasound of rectum 76937 Ultrasound guidance for accessing into blood vessel 76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle 77001 Fluoroscopic guidance for insertion, replacement or removal of central venous access device 77012 Radiological supervision and interpretation of CT guidance for needle insertion 77014 CT scan guidance for insertion of radiation therapy fields 77067 Mammography of both breasts 77263 Management of radiation therapy, complex 77300 Calculation of radiation therapy dose 77334 Radiation treatment devices, design and construction, complex 77427 Radiation treatment management, 5 treatments 78306 Bone and/or joint imaging, whole body 78452 Nuclear medicine study of vessels of heart using drugs or exercise multiple studies 78582 Nuclear medicine study of lung ventilation and blood circulation in the lungs 78815 Nuclear medicine study with CT imaging skull base to mid-thigh 78816 Nuclear medicine study with CT imaging whole body 80053 Blood test, comprehensive group of blood chemicals 80305 Testing for presence of drug 80307 Testing for presence of drug 81002 Urinalysis, manual test 81003 Automated urinalysis test 83036 Hemoglobin A1C level 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test 88291 Interpretation and report of genetic testing 88304 Pathology examination of tissue using a microscope, moderately low complexity 88305 Pathology examination of tissue using a microscope, intermediate complexity 88307 Pathology examination of tissue using a microscope, moderately high complexity 88314 Special stained specimen slides to examine tissue and frozen preparation of specimen including

interpretation and report



HCPCS Code Code Description 88331 Pathology examination of tissue during surgery 88341 Special stained specimen slides to examine tissue 88342 Tissue or cell analysis by immunologic technique 88350 Antibody evaluation 90471 Administration of 1 vaccine 90662 Vaccine for influenza for injection into muscle 90791 Psychiatric diagnostic evaluation 90792 Psychiatric diagnostic evaluation with medical services 90832 Psychotherapy, 30 minutes 90833 Psychotherapy, 30 minutes 90834 Psychotherapy, 45 minutes 90836 Psychotherapy, 45 minutes 90837 Psychotherapy, 60 minutes 90853 Group psychotherapy 90870 Shock treatment and monitoring 90935 Hemodialysis procedure with one physician evaluation 90960 Dialysis services (4 or more physician visits per month), patient 20 years of age and older 90961 Dialysis services (2-3 physician visits per month), patient 20 years of age and older 90962 Dialysis services (1 physician visit per month), patient 20 years of age and older 90966 Home dialysis services per month, patient 20 years of age or older 92004 Eye and medical examination for diagnosis and treatment, new patient, 1 or more visits 92012 Eye and medical examination for diagnosis and treatment, established patient 92014 Eye and medical examination for diagnosis and treatment, established patient, 1 or more visits 92083 Measurement of field of vision during daylight conditions 92133 Diagnostic imaging of optic nerve of eye 92134 Diagnostic imaging of retina 92250 Photography of the retina 92507 Treatment of speech, language, voice, communication, and/or hearing processing disorder 92523 Evaluation of speech sound production with evaluation of language comprehension and expression 92524 Behavioral and qualitative analysis of voice and resonance 92526 Treatment of swallowing and/or oral feeding function 92540 Observation, testing, and recording of abnormal eye movement 92550 Assessment of eardrum and muscle function 92552 Pure tone air conduction threshold hearing assessment 92557 Air and bone conduction assessment of hearing loss and speech recognition 92567 Eardrum testing using ear probe 92610 Evaluation of swallowing function 93000 Routine EKG using at least 12 leads including interpretation and report 93010 Routine electrocardiogram (EKG) using at least 12 leads with interpretation and report 93018 Exercise or drug-induced heart and blood vessel stress test with EKG monitoring, physician interpretation

and report 93042 Interpretation and report of electrical activity of heart using 1-3 leads 93280 Evaluation, testing, and programming adjustment of permanent dual lead pacemaker system with physician

analysis, review, and report 93284 Evaluation, testing and programming adjustment of defibrillator with analysis, review and report 93294 Remote evaluations of single, dual, or multiple lead pacemaker system with qualified health care

professional analysis, review, and report, up to 90 days 93295 Remote evaluations of defibrillator up to 90 days with analysis, review and report 93306 Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function 93308 Follow-up or limited ultrasound examination of heart



HCPCS Code Code Description 93325 Doppler ultrasound study of color-directed heart blood flow, rate, and valve function 93458 Insertion of catheter in left heart for imaging of blood vessels or grafts and left lower heart 93750 Evaluation of lower heart chamber assist device with physician analysis 93880 Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck 93922 Ultrasound study of arteries of both arms and legs 93923 Ultrasound study of arteries of both arms and legs 93926 Ultrasound study of arteries and arterial grafts of one leg or limited 93970 Ultrasound scan of veins of both arms or legs including assessment of compression and functional

maneuvers 93971 Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional

maneuvers 94010 Measurement and graphic recording of total and timed exhaled air capacity 94060 Measurement and graphic recording of the amount and speed of breathed air, before and following

medication administration 94618 Test for exercise-induced lung stress 94726 Determination of lung volumes using plethysmography 94729 Measurement of lung diffusing capacity 95004 Injection of allergenic extracts into skin, accessed through the skin 95024 Injection of allergenic extracts into skin for immediate reaction analysis 95117 Injection of incremental dosages of allergen, 2 or more injections 95165 Preparation and provision of single or multiple antigens for allergen immunotherapy 95251 Ambulatory continuous glucose (sugar) including interpretation and report for a minimum of 72 hours 95806 Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort 95810 Sleep monitoring of patient (6 years or older) in sleep lab 95811 Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by

mask or breathing tube 95816 Measurement and recording of brain wave (EEG) activity, awake and drowsy 95819 Measurement and recording of brain wave (EEG) activity, awake and asleep 95886 Needle measurement and recording of electrical activity of muscles of arm or leg complete study 95909 Nerve transmission studies, 5-6 studies 95910 Nerve transmission studies, 7-8 studies 95911 Nerve transmission studies, 9-10 studies 96132 Neuropsychological testing evaluation by qualified health care professional, first 60 minutes 96365 Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour 96366 Infusion into a vein for therapy, prevention, or diagnosis 96367 Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour 96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention 96375 Injection of different drug or substance into a vein for therapy, diagnosis, or prevention 96413 Infusion of chemotherapy into a vein up to 1 hour 96415 Infusion of chemotherapy into a vein 97110 Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes 97112 Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes 97140 Manual (physical) therapy techniques to 1 or more regions, each 15 minutes 97161 Evaluation of physical therapy, typically 20 minutes 97162 Evaluation of physical therapy, typically 30 minutes 97165 Evaluation of occupational therapy, typically 30 minutes 97166 Evaluation of occupational therapy, typically 45 minutes 97530 Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15

minutes 97535 Self-care or home management training, each 15 minutes


of 25

HCPCS Code Code Description 97597 Removal of tissue from wounds per session 97802 Medical nutrition therapy, assessment and intervention, each 15 minutes 97803 Medical nutrition therapy re-assessment and intervention, each 15 minutes 98926 Osteopathic manipulative treatment to 3-4 body regions 98927 Osteopathic manipulative treatment to 5-6 body regions 98928 Osteopathic manipulative treatment to 7-8 body regions 98929 Osteopathic manipulative treatment to 9-10 body regions 98940 Chiropractic manipulative treatment, 1-2 spinal regions 98941 Chiropractic manipulative treatment, 3 to 4 spinal regions 98942 Chiropractic manipulative treatment, 5 spinal regions 99152 Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15

minutes 99153 Moderate sedation services by physician also performing a procedure, additional 15 minutes 99183 Management and supervision of oxygen chamber therapy per session G0008 Administration of influenza virus vaccine G0009 Administration of pneumococcal vaccine G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination G0108 Diabetes outpatient self-management training services, individual, per 30 minutes G0109 Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes G0179 Physician re-certification for medicare-covered home health services under a home health plan of care

(patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care

G0180 Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial implementation of the plan of care

G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes

G0399 Home sleep test (hst) with type iii portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ecg/heart rate and 1 oxygen saturation

G0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G9678 Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced

services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation

J0696 Injection, ceftriaxone sodium, per 250 mg J0897 Injection, denosumab, 1 mg J1100 Injection, dexamethasone sodium phosphate, 1 mg J1335 Injection, ertapenem sodium, 500 mg J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to

laboratory

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